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Imaging > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

Search pattern for x-ray

A

Alignment
Bone density
Cartilage space
Soft tissue

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2
Q

3 components of alignment in x-ray search pattern

A
  1. Skeletal architecture
  2. Contour
  3. Adjacent bones
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3
Q

2 components of bone density in x-ray search pattern

A
  1. General & local changes

2. Trabecular structure

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4
Q

3 structures of cartilage space in x-ray search pattern

A
  1. Joint space
  2. Subchondral bone
  3. Epiphyseal plates
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5
Q

4 components of soft tissue structures in search pattern for x-ray

A
  1. Muscles
  2. Fat pads & lines
  3. Joint capsules
  4. periosteum
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6
Q

Alignment:

What is “normal” for skeletal architecture

A

Normal size

Normal number

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7
Q

Alignment:

What is “abnormal” for skeletal architecture

A
  1. Absent bones
  2. Extra bones
  3. Deformities
  4. Fractures
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8
Q

Alignment:

What is “normal” for contour of bone?

A

Outline smooth and continuous

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9
Q

Alignment:

What is “abnormal” for contour of bone?

A
  1. Spurs
  2. Avulsions
  3. Impaction
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10
Q

Alignment:

What is “normal” for alignment of adjacent bone?

A
  1. Normal joint articulation

2. Normal spatial relationships

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11
Q

Alignment:

What is “abnormal” for alignment of adjacent bone?

A
  1. Joint subluxations
  2. Joint dislocation
  3. Fracture
  4. Past surgeries
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12
Q

Where are bone spurs often found?

A

Heel

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13
Q

How many growth plates do we initially have? How old are individuals with growth plates that are still forming?

A

7 growth plates

Ages 7-12

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14
Q

Bone density:

What is “normal” with general density?

A
  1. Sufficient contrast between tissue (cortical brighter and more opaque than medullary area)
  2. Sufficient contrast between cancellous and cortical bone
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15
Q

Bone density:

What is “abnormal” with general density?

A
  1. Poor contrast between bone and soft tissue

2. Loss of cortical margin

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16
Q

Bone density:

What is “normal” with trabecular structure?

A

Normal…

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17
Q

Bone density:

What is “abnormal” with trabecular structure?

A

Altered trabecular appearance

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18
Q

Bone density:

What is “normal” with local density changes?

A

Sclerosis in weight bearing stress areas

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19
Q

Bone density:

What is “abnormal” with local density changes?

A
  1. Excessive sclerosis- opaque
  2. Reactive sclerosis
  3. Osteophytes
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20
Q

What is sclerosis?

A

Thickening of the bone, more opaque

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21
Q

Cortical margin of the bone is more ______

A

Opaque

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22
Q

Trabecular lines through the bone can be seen with this condition

A

Osteoporosis

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23
Q

What is a “bone island?”

A

Sclerotic area- isolated in the bone… normal changes, just isolated to one spot

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24
Q

View of a stress fracture- ______ is visible, edge of bone not smooth

A

Lucency

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25
Q

With this condition, the cortical area is stripped of bone in the tibia/fibula

A

Hyperthyroidism

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26
Q

How can you tell if person has OA or RA in the hands?

A

RA typically B/L

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27
Q

Cartilage space:

What is “normal” with joint space?

A

Well preserved

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28
Q

Cartilage space:

What is “abnormal” with joint space?

A

Decreased or altered

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29
Q

Cartilage space:

What is “normal” with subchondral bone?

A

Smooth surface

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30
Q

Cartilage space:

What is “abnormal” with subchondral bone?

A
  1. Excessive sclerosis

2. Erosion

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31
Q

Cartilage space:

What is “normal” with epiphyseal plates?

A

Normal based on skeletal age

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32
Q

Cartilage space:

What is “abnormal” with epiphyseal plates?

A

Asymmetries

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33
Q

How can you tell if x-ray is adult hand or pediatric?

A

Pediatric has more space in the joints, epiphyseal plates visible

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34
Q

Need to consider the ____ of the individual when viewing x-ray

A

age

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35
Q

what happens in degenerative disc disease?

A
  1. Bone changes between the 2 end plates
  2. Discs over time degenerate- position of disc in relation to vertebrae changes
  3. Traction spurs may develop to support protruded disc
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36
Q

Soft tissue:

What is “normal” with muscles?

A

Normal size

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37
Q

Soft tissue:

What is “abnormal” with muscles?

A
  1. Swelling

2. Wasting

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38
Q

Soft tissue:

What is “normal” with fat pads & lines?

A
  1. Parallel to bone

2. Parallel to muscle

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39
Q

Soft tissue:

What is “abnormal” with fat pads & lines?

A

Displacement, elevation or blurring = swelling

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40
Q

Soft tissue:

What is “normal” with joint capsules?

A

Non-distinct (not projecting more than it would normally

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41
Q

Soft tissue:

What is “abnormal” with joint capsules?

A

Distended

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42
Q

Soft tissue:

What is “normal” with periosteum?

A
  1. Non-distinct

2. Reaction in fracture healing

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43
Q

Soft tissue:

What is “abnormal” with periosteum?

A

Periosteal reactions

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44
Q

Soft tissue:

What is “normal” with miscellaneous?

A

Soft tissue normally gray

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45
Q

Soft tissue:

What is “abnormal” with miscellaneous?

A

Radiolucent or radiopaque

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46
Q

How does a fat pad appear on a CT?

A

Lucent area on CT

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47
Q

What is it called when the fat pad becomes inflamed/swollen and expands away from bone (becomes visible on CT)

A

Sail sign

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48
Q

What are the shoulder routine views?

A 
Anteroposterior
Anteroposterior ER
Anteroposterior IR
Lateral
AC joint
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49
Q

What is a hill sacks lesion?

A

Deformity of humeral head when there is deformity- creates what looks like divot across where bony tissue has been deformed

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50
Q

What is a Bankhart fracture?

A

Occurs in glenoid area- lucency along edge where rim of glenoid is fractured

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51
Q

What is a bankhart lesion?

A

Labrum tears away from rim

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52
Q

What are the elbow routine views?

A

Anteroposterior
Lateral
Oblique

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53
Q

What do you want to see from the lateral view of the elbow (indicates good view)

A

Figure 8

Fat pad visible

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54
Q

What are the hand routine views?

A

Posteroanterior
Oblique
Lateral

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55
Q

What is a fracture to the 5th metacarpal called?

A

Boxer’s fx

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56
Q

What are the wrist routine views?

A

Posteroanterior
Oblique
Lateral

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57
Q

What is seen on an x-ray with arthritis of the wrist?

A

Sclerosis between the joints

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58
Q

Why does the scaphoid fracture most easily?

A

Has least movement of all the carpal bones

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59
Q

Hip/pelvis routine views?

A

Anteroposterior

Lateral frog leg

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60
Q

What do trabecular lines indicate?

A

Lucency surrounded by sclerosis suggests it may have started as stress fracture (already attempting to develop more bone in that area)

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61
Q

What does it mean when lucency forms along prosthesis?

A

Prosthesis is loosening

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62
Q

Knee routine views?

A

Anteroposterior
Lateral
Tunnel
Tangential

63
Q

Tangential view of patella aka

A

Sunrise view

64
Q

Foot routine views?

A

Anteroposterior
Lateral
Oblique

65
Q

views of cervical spine?

A 
Anteroposterior upper
Anteroposterior lower
Lateral
Oblique
Stress views
66
Q

What is the difference between a lateral and oblique view of the cervical spine?

A

Oblique shows foramen better- opening more visible in oblique
Lateral shows facet joint better

67
Q

What is a stress view of the cervical spine?

A

In flexion/extension

68
Q

Thoracic spine views?

A

Anteroposterior
Lateral
Oblique

69
Q

Lumbar spine views?

A 
Anteroposterior
Lateral
Oblique
L5-S1
S1 AP
70
Q

What is the best view to see the “Scotty dog” in the lumbar spine?

A

Oblique- can see foramina

71
Q

Deep lucency in the vertebrae indicates _____

A

Osteoporosis- loss of bone density

72
Q

Most common mechanism of injury for shoulder

A

Falls (FOOSH)

73
Q

In elderly osteoporotic female, falls typically result in ________ (relating to shoulder)

A

Surgical neck of humerus fx

74
Q

In younger adults, fractures of _______ may be associated with dislocation of _______ or injury to _______ muscles (SHOULDER RELATED)

A

Humeral head
GH joint
Rotator cuff

75
Q

95% of shoulder dislocations are ______

A

Anterior

76
Q

Shoulder separation refers to ligamentous sprain or rupture at the _______

A

AC joint

77
Q

(SHOULDER) Radiographs adequately demonstrate ____, ____, _____ as well as nontraumatic disorders such as various arthritides

A

Fractures
Dislocations
Calcific tendinitis

78
Q

(SHOULDER) CT provides optimal visualization of ________, especially in characterizing _________ of humeral head

A

Complex fractures

Fracture/dislocation

79
Q

(SHOULDER) MRI used to evaluate glenoid ______, _____ tears, ______ syndromes, instability, and tendon and ______ abnormalities

A

Labrum tears
Rotator cuff
Impingement
Bursa

80
Q

(SHOULDER) Msculoskeletal US equivalent to _____ in evaluation of bursitis, long head of triceps tenosynovitis, and retears of prior surgical rotator cuff repairs. It is superior to ____ in evaluation of rotator cuff tears after _______.

A

MRI
MRI
Total shoulder arthroplasty

81
Q

Most common type of MOI for shoulder injury

A

Falls (FOOSH)

82
Q

________ fx of distal humerus is second most common fx of childhood, following fx of _______

A

Supracondylar

Distal radius

83
Q

________ fractures make up one-third of all fractures at the elbow

A

Radial head

84
Q

______ fractures occur in the elderly as low-energy fxs that result from indirect trauma caused by sudden pull of triceps and brachioradialis muscles

A

Olecranon

85
Q

______ are second most common dislocation in adults and most common major joint dislocation in children

A

Elbow dislocations

86
Q

4 athletic injuries that occur at the elbow

A

Osteochondritis dissecans
Epicondylitis
UCL tear
Snapping triceps

87
Q

Most common MOI to wrist/hand

A

Fall- FOOSH

88
Q

In children, the ______ is the most frequently fractured bone anywhere in skeleton

A

Distal radius

89
Q

In adults the _____ is the most frequently fractured bone in wrist, followed by ___ and ___

A

Distal radius
Scaphoid
Lunate

90
Q

Tears of _____ seen in sports in which there is repetitive force on a wrist positioned in extension and/or ulnar deviation

A

TFCC

91
Q

For unstable AC joint or “shoulder separation,” this view is used with this modification

A

standing AP bilateral views made with and without weights hanging from patient’s hands

92
Q

For assessment of scapula, ____ and ____ views are performed with positioning that removes superimposition of rib cage

A

AP and lateral

93
Q

Indications for MRI of shoulder (8)

A
  1. Rotator cuff pathology
  2. Long head biceps tendon pathology
  3. Glenoid labrum pathology
  4. Soft tissue/osseous coracoacromial arch impingement
  5. Osteochondral and articular cartilage abnormalities
  6. Loose bodies: chondral, osteochondral, or osseous
  7. Marro abnormalities: contusions, osteonecrosis, stress fxs
  8. Neoplasms or infections of bone, joint, or soft tissue
94
Q

included in MRI protocol for shoulder are _____ sequences and _____ sequences

A

Anatomy-defining

Fluid-sensitive

95
Q

_________: contrast is injected into GH joint prior to MRI exam

A

MR arthrography

96
Q

MRI search pattern

A 
Alignment/anatomy
Bone signal
Cartilage
EDema
Soft tissues
97
Q

What is “alignment” in MRI

A

Disruptions of soft tissue attachment to bone, congruity of all joint surfaces and potential spaces for compromise

98
Q

What is “bone signal” in MRI

A

Marrow edema, stress fx, osteochondral injuries, defining ambiguous fx on xray

99
Q

What does “cartilage” show on MRI

A

Assess for abormalities of joint surfaces, labral tears

100
Q

What does edema show on MRI

A

Footprint of injury

Images as intermediate signal on anatomy- defining sequences and high signal on fluid sensitive sequences

101
Q

What do soft tissues show as on MRI

A

Continuity of muscles/tendons, assess ligaments, capsule

102
Q

_____ is imaging modality of choice in skeletal conditions when structural or spatial info f bones and joint articulation is needed

A

CT

103
Q

Primary indications for CT of shoulder:

A 
Severe trauma
Alignment and displacement of fx fragments
Loose bodies in GH joint
Eval of labral/rotator cuff pathology
Any condition typically evaluated by MRI
104
Q

CT imaging principles- What colors are different structures

A

Air = black
Fat = gray-black
Water (soft tissue) = gray
Bone = gray-white

105
Q

Study of choice for evaluation of soft tissue abnormalities, chondral and osteochondral lesions, radiographically occult bone abnormalities

A

MRI

106
Q

Chronic pain persistent that has developed over time in elbow =

A

Chronic elbow pain

107
Q

Term “joint mice” refers to looks bodies within a joint, composed of both bone and cartilage, which can arise from several sources in elbow =

A

Intra-articular osteocartilaginous body

108
Q

Injury that is “hidden” and cannot be easily detected by radiograph in elbow =

A

Occult injury

109
Q

Advanced stage of focal injury to articular cartilage, focal lesion becomes detached from main body of bone in elbow =

A

Unstable osteochondral injury

110
Q

Soft tissue tumors at elbow are rare; mass must be distinguished from infection, trauma, inflammatory process … called a

A

Soft tissue mass

111
Q

Lateral ____ or tennis elbow is inflammation of extensor muscle group’s origin……. medial ______ or golfer’s elbow is inflammation of flexor group’s origin

A

Epicondylitis (lalgia)

112
Q

Tear refers to MCL/UCL/LCL at elbow

A

Collateral ligament tear

113
Q

Bicipitoradial and interosseous bursas around distal biceps tendon can be source of anterior elbow pain if inflamed =

A

Biceps tendon tearbursitis

114
Q

Ulnar nerve is vulnerable to trauma from direct blow to cubital tunnel =

A

Nerve abnormalities

115
Q

Formation of ectopic bone that forms around major joints following brain injury/over long-bone fxs

A

Heterotropic ossification

116
Q

Formation of osteophytes, spurs at joint margins, common in OA

A

Osteophytosis

117
Q

Neoplastic process that occurs within bone

A

Osseous tumor

118
Q

___ centers of ossification at elbow…

Boys ossify ____ later than girls do

A

6

2

119
Q

The _______ and abnormal supinator line are highly associated with ______ at the elbow

A

Positive fat pad sign

Fractures

120
Q 
Collateral, radial, annular ligament tears
Epicondylitis
Distal biceps/triceps tendon tears
Osteochondral lesions
Intra-articular loose bodies
Olecranon/bicipitoradial bursitis
Marrow abnormalities
Ulnar nerve compression
Symptomatic place
Neoplasms or infections of bone, joint, soft tissue
Abnormalities of proximal forearm interosseous membrane....
...... ALL INDICATIONS FOR \_\_\_\_\_\_
A

MRI

121
Q

What anatomy sequence and fluid-sensitive sequence are associated with this orthogonal plane:

AXIAL

A

PD

T2 weighted with fat saturation

122
Q

What anatomy sequence and fluid-sensitive sequence are associated with orthogonal plane:

SAGITTAL

A

T1

T2 weighted with fat saturation

123
Q

What anatomy sequence and fluid-sensitive sequence are associated with orthogonal plane:

CORONAL

A

PD

T2 weighted with inversion recovery

124
Q

MR arthrography is most often used to assess stability of _____ lesion or identify tears of ______ at elbow

A

Osteochondral lesion

Collateral ligaments

125
Q

Indications for CT at elbow (SAALE)

A

Severe trauma
alignment and displacement of fx fragments
Any condition evaluated by MRI if MRI is contraindicated
Loose bodies in elbow joint
Evaluation of osteochondral lesions if MRI is contraindicated

126
Q

MSUS is considered first line examination and is performed in conjunction with ________ at elbow

A

Conventional radiography

127
Q

Pain, swelling, joint instability, presence of mass all warrant use of _______

A

MSUS

128
Q

Define tears, tendinosis, calcification
Define tears of collateral ligaments discriminating between full and partial tears during dynamic valgus/varus test
Eval olecranon and bicipitoradial bursa for burial thickening
Eval articular cartilage
Assess for loose intra-articular bodies
Differentiate complex fluid of effusion from synovitis
Assess nerve entrapment
Dynamically assess nerve and muscle head

….. indications for use of _____

A

MSUS at elbow

129
Q 
Define tendon abnormalities
Define compression neuropathic
Define collateral ligament tears
Differentiate soft tissue masses
Define TFCC tears or degenerative changes
.... all seen with \_\_\_\_\_\_
A

MSUS

130
Q

_____ sufficient to dx phalangeal and metacarpal fractures

A

Radiograph

131
Q

Thumb metacarpal fx, gamekeeper’s thumb, bennett’s fx- all use _____ imaging for dx

A

Oblique views of radiograph, fluoroscopy, CT

132
Q

Fx of scaphoid viewed with ____

A

Radiographs- if non-diagnostic but suspicion for fx is high, can take MRI… CT if MRI unavailable

133
Q

Osteonecrosis of lunate, Kienbock’s disease use ______ for dx

A

MRI most sensitive to marrow changes

134
Q

Tears of TFCC use ____ imaging

A

MRI with dedicated wrist coils and MR arthrography

135
Q

Femur fx use ____ imaging

A

Radiographic for dx, CT may be needed for fragment localization

136
Q

Tibial plateau fx imaging ____

A

Radiographs, 3D CT, MRI (occult fxs via bone marrow edema)

137
Q

Osteochondritis dissecans best viewed with _____

A

Radiographs and MRI

138
Q

ACL best viewed with ____

A

Radiograph to rule out avulsion fx, sagittal MRI

139
Q

Medial meniscus tear use _____ imaging

A

MRI

140
Q

DJD use ____ imaging

A

Radiography

141
Q

Most frequently injured joint in body in adults by trauma

A

Ankle

142
Q

Fractures at ankle can be ___, ___, ____

A

Unimalleolar, bimalleolar, trimalleolar (posterior rim of tibia is 3rd malleolus)

143
Q

Bimalleolus fx use ____ imaging

A

X-ray

144
Q

Fx at base of 5th metatarsal use ____ imaging

A

X-ray, MRI for confirming stress fx

145
Q

Fx of talar neck use ____ imaging

A

X-ray, CT, or MRI

146
Q

Tarsal coalition use ___ imaging

A

X-ray, MRI, CT to determine fibrous or bony coalition

147
Q

Ankle sprain use ____ imaging

A

X-ray to rule out avulsion fx, MRI or US to assess tears

148
Q

Osteomyelitis in foot in patient with DM use ____ imaging

A

MRI

149
Q

Oblique view of foot is performed from perspective of _____ degrees between AP and lateral views

A

45

150
Q

____ and ____ define anatomy in MRI, _____ detects abnormal fluid

A

PD, T1

T2

151
Q 
Severe trauma
Complex fractures and dislocations
Loose bodies in joint 
Tarsal coalition
Osteochondral lesions
Pre-op planning
.... use \_\_\_\_ imaging
A

CT

152
Q

Clinical symptoms that use MSUS for examination (along with conventional xray)

A

Pain
Swelling
Joint instability
Presence of mass

153
Q 
\_\_\_\_ used for 
Achilles' tendon disorders
Tib post disorders
ATFL/CFL/Deltoid ligament tears
Soft tissue or issues impingement
Osteochondral and articular cartilage abnormalities
Loose bodies
Plantar fasciitis
Marrow abnormalities
Neoplasms or infections
Congenital or developmental conditions
A

MRI

Imaging (2 decks)

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